UnitedHealthcare's Medicare Advantage plan members may see changes next year

SEBRING - Dr. Fabio Oliveros & Associates' staff members have been calling their more than 400 patients who have UnitedHealthcare's Medicare Advantage plan, letting them know the insurance company has dropped the two nephrologists from network for next year, and that patients will have to switch plans if they want to continue seeing the doctors.

A few miles away, Drs Vinod Thakkar, Martin Avalos and Pankaj Patel's patients are also finding out the three gastroenterologists will no longer be on the network for the plan, officially called the AARP Medicare Complete Choice Plan 2.

Oliveros' administrative assistant Susana Hendrick, who also is a plan member, is so upset she is switching to traditional Medicare next year, she said.

The five specialists are among at least 12 to 14 physicians in Highlands County whose AARP Medicare Complete Choice Plan 2 contracts for next year reportedly have not been renewed.

It has caused a tizzy among local physicians and is forcing Medicare subscribers to take a closer look during open enrollment period, which began Oct. 15 and ends Dec. 7.

Hendrick provided to Highlands Today a letter to United Healthcare's Senior Vice President Katherine Miller, written by Oliveros and signed by 12 local physicians, expressing their disappointment and letting her know they will advise their patients to find alternate coverage.

"Your actions discontinuing participation in the Medicare Advantage network will preclude many of the patients in Highlands County from receiving medical attention from the physicians that have been treating them for many years," the letter states. "Never before have we seen an insurance company taking actions such as these in detriment to the patient's healthcare needs."

In another letter, Sandy Ferretti, who wrote to the company on behalf of gastroenterologist Dr. Francesco Ferretti, said the doctor is only one of four gastroenterologists who provides hospital coverage in Highlands County.

"This decision will also hinder the local hospital's ability to provide an adequate GI emergency and inpatient care service if Dr. Ferretti is on-call but cannot treat a patient because of this decision," the letter states. "Those patients may be transferred out of the county to a facility where a specialist is participating, at the insurance provider's expense, a costly and wholly unnecessary process."

Hendrick said while their patients are aware of the change, she is worried new Medicare recipients or those re-enrolling in the plan may not be aware their doctor is no longer in network and may have to go out of town to seek treatment from a physician they don't know.

"My thing is, 'Are your doctors covered?,'" she said. She's asking patients who have the coverage and want to continue with it next year to "make sure all the doctors they are using are on the plan."

Local UnitedHealthcare agent Colleen McNally said she has been told the number of network providers was being "streamlined" to keep the cost down for subscribers.

She said she didn't know the exact number of local providers the company was dropping for its Medicare Advantage plan, although she emphasized they all have a right to appeal.

The plan does not carry a premium as long as subscribers pay the Medicare Part B premiums. Patients have to pay co-pays and co-insurance amounts.

Patients can still keep seeing their own doctors even if they are not in network, she explained, although their co-pay and co-insurance amounts will be higher.

As an example: the 2014 co-pay for a specialist is $50 for an in-network doctor and $70 for someone who is out-of-network, she said.

She said UnitedHealthcare is one of the biggest providers and is relying on its reputation to help them go through the change.

Her mother, Sandra Pennisi, who has had the AARP Medicare Complete Choice Plan 2 for five years, said she has had no problems so far and intends to keep it next year.

Meanwhile, the insurance company's changes appear to have affected other parts of Florida as well.

said they have received "a flurry of calls from our physician members."

"We have advised our physicians that the best thing they can do is educate patients," she wrote in an email. "Physicians can tell patients that there is nothing requiring them to stay with United. In fact, patients can switch to a plan with which their physician works to maintain the relationship with that physician."

The Florida Medical Association believes in the continuity of care and patient access, she added.

"We will work with patients and our physicians to make sure nothing gets in the way of that, including insurance companies," she added.

Elizabeth Calzadilla-Fiallo, UnitedHealthcare's director of public relations for Florida and the Gulf States region, said the company's focus is to offer broad access to physicians "who in our view can provide quality, affordable care for more of the people enrolled in our plans."

The company has notified affected UnitedHealthcare members and is "taking steps to help minimize disruption in their care," she wrote in an email.

Members can choose other providers in the network, she said.

In some plans, members can keep seeing their current providers on an out-of-network basis, in accordance with their out-of-network benefits, she said. "These changes have no impact on plan benefits. Members undergoing a treatment plan may request to continue care with an out-of-network provider," she said.

She encouraged members with questions to call the customer service number on the back of their member ID card for more information.